Recurrent squamous cell carcinoma in a post cardiac transplant patient

Anushka S Ruwanpathirana; Samantha J Fernando; M Vinati Molligoda; Jay G Fernando; Wayne W Zhang; Shyamal Premaratne

doi:10.1016/j.ijscr.2021.01.031

Recurrent squamous cell carcinoma in a post cardiac transplant patient

Int J Surg Case Rep. 2021 Feb:79:275-280. doi: 10.1016/j.ijscr.2021.01.031. Epub 2021 Jan 15.

Authors

Anushka S Ruwanpathirana¹, Samantha J Fernando², M Vinati Molligoda³, Jay G Fernando⁴, Wayne W Zhang⁵, Shyamal Premaratne⁶

Affiliations

¹ Ohio State University, Columbus, OH, United States.
² University of North Carolina, Wilmington, NC, United States.
³ Knox College, Galesburg, IL, United States.
⁴ Carolina Physicians Group, Charlotte, NC, United States.
⁵ Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA, United States.
⁶ Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, United States. Electronic address: spremaratne@vuu.edu.

Abstract

Introduction and importance: Solid organ transplantation has evolved along with dramatic advancements in definitive treatment for irreversible and uncompensated organ failure. Transplanted organ survival has improved as a result of reduced allograft rejection. However, negative long-term outcomes which were largely due to the adverse effects of rapidly evolving immunosuppressive regimens are still evident. The emergence of malignancies following prolonged exposure to immunosuppression treatment has affected the quality of life in transplant recipients. They are approximately one hundred times more likely to develop squamous cell carcinoma (SCC) compared to the general population and the incidence of malignant melanomas, basal cell carcinomas, and Kaposi's sarcomas are also on the rise. The incidence of de novo malignancies ranges from 9 to 21% and is commonly seen in the skin and the lymphoreticular system in these patients.

Case presentation: A 78-year-old male presented with a lump in the right axilla, which had grown in size over a 4-week period. Patient had received a cardiac transplant 9 years prior and was on a regimen of Tacrolimus and Mycophenolate Mofetil since then.

Clinical discussion: Following 4 years of immunosuppression therapy, the patient developed a non-healing ulcer on his right forearm and the biopsy confirmed SCC. The recent biopsy performed on the new axillary lump also confirmed SCC. Iatrogenic immune suppressive treatment is associated with the occurrence of de novo, non-melanoma skin cancers in the solid organ transplant recipients and this necessitates early and comprehensive cancer surveillance models to be included in the pre and post-transplant assessment.

Conclusion: Advances in immunology suggest that peripheral blood mononuclear cell sequencing and immune profiling to identify immune phenotypes associated with keratinocyte cancers allow us to recognize patients who are more susceptible for SCC following organ transplantation and immunosuppression.

Keywords: Cancer; Heart transplantation; Immunosuppression; Squamous cell carcinoma.

Publication types

Case Reports